Evidence of Gut Enteropathy and Factors Associated with Undernutrition Among Slum-dwelling Adults in Bangladesh

Overview

Journal Am J Clin Nutr

Publisher Elsevier

Specialty Nutritional Sciences

Date 2020 Jan 8

PMID 31909785

Citations 6

Authors

Shah Mohammad Fahim

Subhasish Das

Md Amran Gazi

Md Ashraful Alam

Mustafa Mahfuz

Tahmeed Ahmed

Affiliations

Soon will be listed here.

Abstract

Background: Adult undernutrition (BMI <18.5 kg/m2) is responsible for immune deficits, increased risk of disease burden, and higher rates of mortality. The prevalence of adult undernutrition in Bangladesh is substantial, but there have been few studies on the etiology of this condition for the inhabitants of urban slums.

Objective: The aim of this study was to identify the factors associated with undernutrition among slum-dwelling adults in Bangladesh.

Methods: A case-control study was conducted in the Bauniabadh area of Dhaka, Bangladesh. 270 adult participants (135 cases with a BMI <18.5 and 135 controls with a BMI between 18.5 and 24.9) aged 18-45 y were enrolled between October 2018 and January 2019. Sociodemographic variables, dietary diversity, micronutrient deficiencies, psychological symptoms, infection, and biomarkers of gut health were assessed to identify the factors associated with undernutrition using multivariable logistic regression analysis.

Results: A higher number of siblings [adjusted odds ratio (aOR): 1.39; 95% CI: 1.11, 1.77], increased self-reporting questionnaire-20 score (an instrument to screen mental health disorders and detect psychological symptoms) (aOR: 1.12; 95% CI: 1.04, 1.23), elevated fecal concentration of α-1 antitrypsin (aOR: 4.82; 95% CI: 1.01, 25.29), and anemia (aOR: 3.63; 95% CI: 1.62, 8.58) were positively associated with undernutrition in adults. Age (aOR: 0.90; 95% CI: 0.84, 0.96), dietary diversity score (aOR: 0.75; 95% CI: 0.56, 0.99), C-reactive protein (aOR: 0.82; 95% CI: 0.73, 0.92), Helicobacter pylori infection (aOR: 0.11; 95% CI: 0.05, 0.23), and always washing hands before eating or preparing foods (aOR: 0.33; 95% CI: 0.12, 0.87) were associated with reduced odds of undernutrition among the study population.

Conclusions: Our results indicate that undernutrition in slum-dwelling adults in Bangladesh is associated with numerous physiological and sociodemographic factors, including evidence of gastrointestinal inflammation and altered intestinal permeability.

Citing Articles

Wealth-based inequality in underweight among Scheduled Tribe women in India: a regional analysis.

Singh A, Singh A, Chakrabarty M, Singh S, Tripathi P Int J Equity Health. 2025; 24(1):27.

PMID: 39849479 PMC: 11756192. DOI: 10.1186/s12939-025-02392-8.

Small Intestine Bacterial Overgrowth is associated with increased Campylobacter and epithelial injury in duodenal biopsies of Bangladeshi children.

Fahim S, Donowitz J, Smirnova E, Jan N, Das S, Mahfuz M PLoS Negl Trop Dis. 2024; 18(3):e0012023.

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Alteration of stool pH and its association with biomarkers of gut enteropathy among slum-dwelling women of reproductive age in Bangladesh.

Mostafa I, Hasan S, Gazi M, Alam M, Fahim S, Saqeeb K BMC Womens Health. 2023; 23(1):661.

PMID: 38071298 PMC: 10710701. DOI: 10.1186/s12905-023-02758-6.

Nutritional status and dietary diversity of pregnant and nonpregnant reproductive-age Rohingya women.

Fahim S, Das S, Rasul M, Zaman M, Alam M, Afrin S Food Sci Nutr. 2023; 11(9):5523-5531.

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Subclinical Kwashiorkor in Adults: A New Age Paradigm.

Kapoor N, Bhattacharya S, Agarwal N, Das S, Bantwal G, Deshmukh V Indian J Endocrinol Metab. 2022; 26(3):213-222.

PMID: 36248046 PMC: 9555378. DOI: 10.4103/ijem.ijem_42_22.

References

Fernald L . Socio-economic status and body mass index in low-income Mexican adults. Soc Sci Med. 2007; 64(10):2030-42. PMC: 1924923. DOI: 10.1016/j.socscimed.2007.02.002. View

Siddiqui M, Donato R . Undernutrition among adults in India: the significance of individual-level and contextual factors impacting on the likelihood of underweight across sub-populations. Public Health Nutr. 2016; 20(1):130-141. PMC: 10261381. DOI: 10.1017/S1368980016001968. View

Kao T, Lu I, Liao K, Lai H, Loh C, Kuo H . Associations between body mass index and serum levels of C-reactive protein. S Afr Med J. 2009; 99(5):326-30. View

Pryer J, Rogers S . Epidemiology of undernutrition in adults in Dhaka slum households, Bangladesh. Eur J Clin Nutr. 2006; 60(7):815-22. DOI: 10.1038/sj.ejcn.1602385. View

Nithya D, Bhavani R . DIETARY DIVERSITY AND ITS RELATIONSHIP WITH NUTRITIONAL STATUS AMONG ADOLESCENTS AND ADULTS IN RURAL INDIA. J Biosoc Sci. 2017; 50(3):397-413. DOI: 10.1017/S0021932017000463. View

Shetty P, James W . Body mass index. A measure of chronic energy deficiency in adults. FAO Food Nutr Pap. 1994; 56:1-57. View

Baek O, Fabiansen C, Friis H, Ritz C, Koch J, Willesen J . Malnutrition Predisposes to Endotoxin-Induced Edema and Impaired Inflammatory Response in Parenterally Fed Piglets. JPEN J Parenter Enteral Nutr. 2019; 44(4):668-676. DOI: 10.1002/jpen.1705. View

Kosek M, Haque R, Lima A, Babji S, Shrestha S, Qureshi S . Fecal markers of intestinal inflammation and permeability associated with the subsequent acquisition of linear growth deficits in infants. Am J Trop Med Hyg. 2012; 88(2):390-396. PMC: 3583335. DOI: 10.4269/ajtmh.2012.12-0549. View

Thorne-Lyman A, Valpiani N, Sun K, Semba R, Klotz C, Kraemer K . Household dietary diversity and food expenditures are closely linked in rural Bangladesh, increasing the risk of malnutrition due to the financial crisis. J Nutr. 2009; 140(1):182S-8S. DOI: 10.3945/jn.109.110809. View

10.

Naidu A, Rao N . Body mass index: a measure of the nutritional status in Indian populations. Eur J Clin Nutr. 1994; 48 Suppl 3:S131-40. View

11.

Calder P, Jackson A . Undernutrition, infection and immune function. Nutr Res Rev. 2008; 13(1):3-29. DOI: 10.1079/095442200108728981. View

12.

Siddiqui B, Yakoob J, Abbas Z, Azmat R, Fatima S, Awan S . Distribution of Helicobacter pylori infection and abnormal body- mass index (BMI) in a developing country. J Infect Dev Ctries. 2019; 12(5):342-346. DOI: 10.3855/jidc.10051. View

13.

Degarege A, Hailemeskel E, Erko B . Age-related factors influencing the occurrence of undernutrition in northeastern Ethiopia. BMC Public Health. 2015; 15:108. PMC: 4324415. DOI: 10.1186/s12889-015-1490-2. View

14.

Salles N, Menard A, Georges A, Salzmann M, de Ledinghen V, De Mascarel A . Effects of Helicobacter pylori infection on gut appetite peptide (leptin, ghrelin) expression in elderly inpatients. J Gerontol A Biol Sci Med Sci. 2006; 61(11):1144-50. DOI: 10.1093/gerona/61.11.1144. View

15.

Naylor C, Lu M, Haque R, Mondal D, Buonomo E, Nayak U . Environmental Enteropathy, Oral Vaccine Failure and Growth Faltering in Infants in Bangladesh. EBioMedicine. 2016; 2(11):1759-66. PMC: 4740306. DOI: 10.1016/j.ebiom.2015.09.036. View

16.

Rai R, Fawzi W, Bromage S, Barik A, Chowdhury A . Underweight among rural Indian adults: burden, and predictors of incidence and recovery. Public Health Nutr. 2017; 21(4):669-678. PMC: 5849053. DOI: 10.1017/S1368980017003081. View

17.

Holdoway A, Anderson L . What more can community nurses do to manage adult malnutrition. Br J Community Nurs. 2019; 24(Sup7):S6-S10. DOI: 10.12968/bjcn.2019.24.Sup7.S6. View

18.

Arimond M, Wiesmann D, Becquey E, Carriquiry A, Daniels M, Deitchler M . Simple food group diversity indicators predict micronutrient adequacy of women's diets in 5 diverse, resource-poor settings. J Nutr. 2010; 140(11):2059S-69S. PMC: 2955880. DOI: 10.3945/jn.110.123414. View

19.

van der Pols-Vijlbrief R, Wijnhoven H, Molenaar H, Visser M . Factors associated with (risk of) undernutrition in community-dwelling older adults receiving home care: a cross-sectional study in the Netherlands. Public Health Nutr. 2016; 19(12):2278-89. PMC: 10270920. DOI: 10.1017/S1368980016000288. View

20.

Letamo G, Navaneetham K . Prevalence and determinants of adult under-nutrition in Botswana. PLoS One. 2014; 9(7):e102675. PMC: 4108334. DOI: 10.1371/journal.pone.0102675. View